Concept Development Analyst – Automated Concepts

🕒 Maio 13

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $95.000 - $121.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🧐 Analista

🦅 Patrocina Visto H1B

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Cotiviti

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

⚕️ Seguro de Saúde

💳 Fintech

🤖 Inteligência Artificial

Healthcare Insurance • Fintech • Artificial Intelligence

Cotiviti é uma empresa de tecnologia e análise em saúde que se especializa em melhorar a precisão e o desempenho dos pagamentos por meio de soluções avançadas de análise de dados. Eles se associam a planos de saúde, agências governamentais e provedores de serviços de saúde para fornecer insights que aprimoram a qualidade e a eficiência na prestação de cuidados. Com soluções como ajuste de risco, gerenciamento de políticas de pagamento e engajamento de membros, a Cotiviti busca otimizar os resultados financeiros e clínicos para o ecossistema de saúde.

Descrição

• Support the enhancement and ongoing optimization of claim selection processes and tools. • Apply deep clinical, coding, analytical, and reimbursement expertise to strengthen and operationalize existing selection strategies. • Contribute to improvements in proprietary claim selection tools that drive accurate, compliant, and scalable payment integrity outcomes. • Provide coding guidance, analytical insights, and validation to inform model development, tuning, and output evaluation. • Analyze selection outputs and take meaningful action based on audit performance trends.

🎯 Requisitos

• Minimum of 5 years of experience in data analytics, medical billing, inpatient and outpatient coding, auditing, or CDI. • Bachelor’s or Graduate degree required. • Proficiency in at least one and desire to learn others as needed: Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), Emergency Room, Behavioral Health. • Proficiency in Microsoft Excel required. • Able to conduct basic data analyses independently. • Mastery of healthcare coding systems and payment methodologies (CPT, HCPCS, ICD-10, HIPPS, and Revenue Codes, etc.). • AAPC or AHIMA coding certification preferred. • Proficient with healthcare claim adjudication standards and procedures. • Excellent verbal and written communication skills. • Strong analytical and investigative skills. • Working knowledge of HIPAA Privacy and Security Rules and CMS security requirements. • Ability to work independently, prioritize tasks, and document progress. • Prior auditing or consulting experience in either a provider or payer environment is desirable. • Experience using AI-enabled tools (e.g., ChatGPT, Copilot, or similar).

🏖️ Benefícios

• Medical insurance • Dental insurance • Vision insurance • Disability insurance • Life insurance • 401(k) retirement plan • Paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti